Pregnancy and Thalassemia: Health of the Baby (p5)

Risks Related to Medications
Genetic counseling is an important resource for information about the adverse effects of maternal medications on the developing fetus. It is important for any pregnant woman to consult her physician before using any type of medication. Potential risks to the fetus depend on the type of medication, the dosage, and the period in pregnancy in which exposure takes place. Certain medications may also be present in breast milk and may pose a risk to the newborn baby. A genetic counselor or perinatologist can offer information about any particular woman's risk.

The woman with thalassemia may be on one or more medications, including iron chelating agents or anti-viral drugs to manage previous infections. Known or theoretical risks of each of these medications should be considered in determining whether they should be continued in pregnancy or if their doses should be adjusted. Desferal is the most commonly used medication among these women because of its important role in reducing iron overload and its consequences. The possibility of adverse effects is suggested by animal studies in which skeletal anomalies are noted at doses comparable to human dosages. Less than 40 cases among pregnant women have been published describing the outcome of pregnancy for women on chronic Desferal treatment. Among the women who continued their pregnancies, none took Desferal beyond the first trimester. There was no evidence among these infants to suggest adverse effects of Desferal. Some additional cases have been reported in which Desferal therapy was initiated late in pregnancy following iron overdose. At least one of these infants was reported to have iron deficiency attributable to maternal Desferal therapy. Overall, the number of reported cases in women is insufficient to establish the safety of Desferal in pregnancy. Regarding the safety during breast-feeding, Desferal is unlikely to have a harmful effect given its poor absorption across the adult gut. However, there is no available information regarding Desferal treatment during breast-feeding. Therefore, the expected benefits and risks of continuing therapy during pregnancy or breast-feeding for any individual woman should be discussed with her physician. This is true for any additional medications given to the pregnant woman with thalassemia.

Risks Related to Infectious Agents
Screening for infectious agents is an important part of prenatal care for any pregnant woman. Certain types of maternal infection may carry a risk of transmission to the fetus or have other adverse health effects on the fetus. These effects and the chance for fetal or perinatal infection depend on several factors: the type of agent, the severity of maternal infection, the amount of virus or other infectious agent present, the stage of pregnancy, and the mode of delivery. Information about a woman's specific risks can be obtained from a genetic counselor and/or a perinatologist. Although the safety of our nation's blood supply has increased dramatically over the last several years, blood transfusions continue to be a risk factor for acquiring certain infections. Women with thalassemia who are considering becoming pregnant should be screened for all forms of hepatitis and HIV infection prior to conception. If one of these infections is identified, specific information regarding the health risks and chance of transmission to the developing fetus is available. In some cases, preventative treatment or alternative options for delivery may be considered to help reduce the risk of transmission to the baby. <back>

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